Healthcare Provider Details

I. General information

NPI: 1346753456
Provider Name (Legal Business Name): LISA MICHELLE MCCONNELL APRN-CNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA MICHELLE PATISON

II. Dates (important events)

Enumeration Date: 11/10/2017
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2212 N BROADWAY ST
MOORE OK
73160-4303
US

IV. Provider business mailing address

2212 N BROADWAY ST
MOORE OK
73160-4303
US

V. Phone/Fax

Practice location:
  • Phone: 405-285-7222
  • Fax: 405-285-7227
Mailing address:
  • Phone: 405-285-7222
  • Fax: 405-285-7227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number109623
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number109623
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number109623
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: